Provider Demographics
NPI:1811234446
Name:DO, JOHNSON (PHARM D)
Entity Type:Individual
Prefix:
First Name:JOHNSON
Middle Name:
Last Name:DO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 N GOLDENROD RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8999
Mailing Address - Country:US
Mailing Address - Phone:407-681-3191
Mailing Address - Fax:407-681-3194
Practice Address - Street 1:4000 N GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8999
Practice Address - Country:US
Practice Address - Phone:407-681-3191
Practice Address - Fax:407-681-3194
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0034272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist